Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-10-6

Copayment Policy

Notice of Proposed Rule

(Amendment)

DAR File No.: 33415
Filed: 03/01/2010 03:54:38 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to consolidate the Medicaid copayment policy into one administrative rule.

Summary of the rule or change:

This change removes the specific requirements of the copayment policy and references those requirements to Rule R414-1. (DAR NOTE: The proposed amendment to Rule R414-1 is under DAR No. 33414 in this issue, March 15, 2010, of the Bulletin.)

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

The explanation of impact to the state budget is detailed in the companion filing to this proposed change (Rule R414-1).

local governments:

The explanation of budget impact to local governments is detailed in the companion filing to this proposed change (Rule R414-1).

small businesses:

The explanation of budget impact to small businesses is detailed in the companion filing to this proposed change (Rule R414-1).

persons other than small businesses, businesses, or local governmental entities:

The explanation of budget impact to persons other than small businesses, businesses, or local government entities is detailed in the companion filing to this proposed change (Rule R414-1).

Compliance costs for affected persons:

The explanation of compliance costs for affected persons is detailed in the companion filing to this proposed change (Rule R414-1).

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule change implements requirements of the American Recovery and Reinvestment Act of 2009 and will have no fiscal impact on business since the Medicaid program will absorb the cost.

David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

04/14/2010

This rule may become effective on:

04/21/2010

Authorized by:

David Sundwall, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-10. Physician Services.

R414-10-6. Copayment Policy.

[This section establishes copayment policy for physician services for Medicaid clients who are not in any of the federal categories exempted from copayment requirements. is authorized by 42 CFR 447.15 and 447.50, Oct. 1, 2000 ed., which are adopted and incorporated by reference.

(1) The Department shall impose a copayment in the amount of $3 for each physician visit when a non-exempt Medicaid client, as designated on his Medicaid card, receives that physician service. The Department shall limit the out-of-pocket expense of the Medicaid client to $100 annually.

(2) The Department shall deduct $3 from the reimbursement paid to the provider for each physician visit, limited to one per day.

(3) The provider should collect the copayment amount from the Medicaid client for each physician visit, limited to one per day. The provider may deny service for any client who refuses to make the copayment if the client's medical card indicates copayment is required.

(4) Medicaid clients in the following categories are exempt from copayment requirements:

(a) children;

(b) pregnant women;

(c) institutionalized individuals;

(d) individuals whose total gross income, before exclusions or deductions, is below the Temporary Assistance to Needy Families (TANF) standard payment allowance. These individuals must indicate their income status to their eligibility case worker on a monthly basis to maintain their exemption from the copayment requirements.

(5) Physician services for family planning purposes are exempt from the copayment requirements.]Each Medicaid client is responsible to pay a copayment amount that complies with the requirements of the Utah Medicaid State Plan and Rule R414-1.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [December 28, 2006] 2010

Notice of Continuation: January 26, 2007

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3